Department of Justice Seal

Remarks of

Acting Associate Attorney General Daniel Marcus

Elder Justice: Medical Forensic Issues in Elder
Abuse and Neglect

October 18, 2000

Good morning. I 'd like to welcome you to our Elder Justice forum on medical forensic issues in elder abuse and neglect. We appreciate your having made the considerable effort -- often on short notice -- to give us the benefit of your expertise in addressing these challenging issues.

In selecting who should participate in this discussion, it was striking how many roads led again and again to the same names. You are a select and distinguished community of experts. That being said, not only are today's participants pre-eminent in their respective fields, but so too are the individuals who are here as observers. Unfortunately, we have only a very few hours today to discuss this complex topic. Thus, in the interest of having a manageable, focused discussion, we have had to limit the number of participants, despite our desire to include many more of you. We hope, however, that the discussion today will be a springboard to many more discussions with all of you.

In that spirit, we invite both participants and observers to join us at an informal gathering after we break at 4:30 this afternoon at a restaurant next door called Coco Loco. They have agreed to open a little early and serve a variety of beverages and tapas, among other things.

Let me tell you very briefly who is represented at the table today. You are geriatricians, medical examiners, psychiatrists, pediatricians, nurses, social scientists, sociologists, and psychologists. You are experts in internal medicine, family medicine, emergency medicine, elder sexual abuse, developing forensic centers, and in the forensic application of large amounts of clinical data. You are the experts in elder abuse and neglect from the National Institute on Aging and Adult Protective Services; and you are prosecutors and law enforcement officials representing federal, state and local agencies.

Many of you have done ground-breaking research in this area, developed creative multi-disciplinary response teams and clinical practices, and pursued vital prosecutions and training efforts. And people like Dr. Rosalie Wolf and Dr. Karl Pillemer have been pioneers for decades in the fight against elder abuse and neglect.

We are very grateful to each of you -- participants and observers alike -- for joining with us today in the exciting opportunity to lay the groundwork in addressing this difficult and important issue.

The number of older Americans will more than double in the next 30 years. But we have a long way to go in learning how to detect and diagnose elder abuse and neglect, and in obtaining consensus on what forensic markers demand additional inquiry and action. We have a long way to go in promoting multi-disciplinary efforts at the national, state and local levels. These efforts must include healthcare, social service, public safety and law enforcement professionals. We have a long way to go in educating those professionals about elder abuse and neglect. And we must urge them to conduct research that will help us prevent, treat, intervene in and, where necessary, prosecute cases of elder abuse and neglect.

The goal of this roundtable discussion is to make progress in each of these areas and to promote the critical multi-disciplinary efforts in which so many of you are engaged. We hope that today's discussion will give you useful ideas to take back to your respective institutions; to include in your training curricula and clinical practices; to catalyze research proposals that will fill the current gaps in our knowledge; and to promote funding of all of these efforts. We also want to hear from you what you think we should be doing. There is so much to do that we must use the scarce resources devoted to this area wisely.

We have two moderators today. Dr. Laura Mosqueda - a clinician, researcher, and educator - is the Director of Geriatrics at University of California Irvine where she is also an Associate Clinical Professor of Family Medicine. Dr. Mosqueda, who is board certified in family medicine and geriatrics, is the principal investigator on a three-year project investigating the use of multi-disciplinary teams for evaluation of elder abuse cases. In another study, she also recently completed the collection of pilot data on the natural history of bruising in older people and what patterns of bruising should raise a suspicion of abuse. Dr. Mosqueda also is involved in education, having created a day-long course in elder abuse for geriatricians. In addition, she has testified in numerous cases relating to elder abuse.

As the second moderator, we have one of our own Department attorneys, David Hoffman. David is an Assistant United States Attorney in Philadelphia. He brought the first civil False Claims Act case to redress systemic abuse and neglect in a nursing home in 1996. Since then, he has settled five such cases. Perhaps the most significant remedies in David's cases are not the monetary damages, but the measures designed to protect residents - for example, the imposition of temporary monitors and other requirements to improve deficient areas in a single facility or chain of facilities. Before becoming a federal prosecutor, David was chief counsel to the Pennsylvania Department of Aging.

We are very grateful to Laura and to David for their contributions to this effort. I'd also like to thank MT Connolly, coordinator of the Department's Nursing Home Initiative; the Office for Policy Development, and particularly Andrea Tisi; our Office of Justice Programs; Carol Cribbs of the Justice Management Division; and our contractor Pam Frank.

I look forward to hearing about your discussion and to reading the resulting publication which will include your papers and a summary of your discussion today.

Now I will turn the floor over to Laura and David.